Provider Demographics
NPI:1679683320
Name:WARREN A RUBIN DPM
Entity Type:Organization
Organization Name:WARREN A RUBIN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-964-0014
Mailing Address - Street 1:431 KAIGHN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-2209
Mailing Address - Country:US
Mailing Address - Phone:856-964-0014
Mailing Address - Fax:856-427-4036
Practice Address - Street 1:431 KAIGHN AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2209
Practice Address - Country:US
Practice Address - Phone:856-964-0014
Practice Address - Fax:856-427-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00096400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
124429Medicare ID - Type Unspecified
T44739Medicare UPIN